Increase or decrease? Advice needed from ven users/med experts!

[PixieP]

Hi
So 4 weeks ago I started ven (have been on it in the past, reintroduced last year without success, but my psych wanted me to try again. I'm also still on Pregabalin and mirtazapine, neither doing much and to be reduced once ven kicks in, if it even does).
First week my dose was 37.5mg xr and I was supposed to increase to 75mg after a week but I'm scared of the side effects upping too quickly so I alternated 37.5/75 for a week. I'm not sure whether it was the med or "just me" but after a few days on this dose I felt better (waking anxiety but then improved as the days went on each day). After a week on this dose I saw my psych again who said I should move to 75 every day as this is the minimum effective dose.
I've now been on 75mg for 2 weeks and apart from one good day I've been feeling awful again. The psych said if I felt no improvement I should increase to 112.5 and then 150 but I'm not sure......
Is it possible that I was getting benefit at the lower dose? If so I'd rather just reduce although I was on 112.5mg max dose a few years ago (but after 75mg had helped initially).
I literally hate taking all these meds as I really don't know what's helping (if anything) and what's "just me" any more.
I'm not due to see my gp for another 3 weeks and my psych said I don't need her permission to alter the dose.
Any expert opinions would be gratefully received.

[panic_down_under]

First week my dose was 37.5mg xr and I was supposed to increase to 75mg after a week but I'm scared of the side effects upping too quickly so I alternated 37.5/75 for a week. I'm not sure whether it was the med or "just me" but after a few days on this dose I felt better (waking anxiety but then improved as the days went on each day).

It was almost certainly "just you" as meds don't work that quickly.

I've now been on 75mg for 2 weeks and apart from one good day I've been feeling awful again.

The onset or increase in side-effects may be most responsible for this. Unfortunately, this is quite common, both at the beginning and for a while after dose increases.

I was on 112.5mg max dose a few years ago (but after 75mg had helped initially).

Antidepressants tend to be less effective the second time around so higher doses than before are usually needed, not less, especially given venlafaxine failed to work when you tried it last year. The other meds you're on may be countering this to a degree, but I'd still be surprised if 75mg did the trick, let alone even less.

[PixieP]

Thanks for your reply PDU.
I'm aware that meds can take several weeks before the full effect, beneficial or otherwise, is felt but how long do side effects generally last? My psych said give it at least 2 weeks at 75 and then increase if I don't feel any better or if I feel better but need more. My GAD is ever present (with the exception of one day in the week when it just dissipated). I'm not actually "anxious" about anything, I just have intense physical feelings all the time whether I'm at home or out and about. It's just so physically and mentally tiring after 10 months.
So do I stick it out at 75mg for another few weeks or just bite the bullet and increase tomorrow? Last time on ven I had no side effects at all and felt better within 2 weeks. Now after so many months I'm starting to lose hope of ever feeling normal again. I'm having CBT but when there's nothing but fear of fear to treat its very hard to break the cycle!

[panic_down_under]

how long do side effects generally last?

Unfortunately, this is a 'how long is a piece of string' question for which there is no definitive answer. They usually begin to diminish within a couple of weeks of starting, however, as with all things antidepressant, this isn't a guarantee.

So do I stick it out at 75mg for another few weeks or just bite the bullet and increase tomorrow?

I suspect you will need to increase the dose at some point. Any spike in anxiety from the dose increase will be about the same if you do it now or in another month or two.

Last time on ven I had no side effects at all and felt better within 2 weeks.

In addition to antidepressants gradually becoming less effective with each discontinuation and restart, their side-effects tend to become progressively more severe and/or different each time too.

Now after so many months I'm starting to lose hope of ever feeling normal again.

I'm sure you can get anxiety under control again. Whether venlafaxine will do it I can't say, but there are other options still to be explored.

[Utah49er]

Thanks for your reply PDU.
I'm aware that meds can take several weeks before the full effect, beneficial or otherwise, is felt but how long do side effects generally last? My psych said give it at least 2 weeks at 75 and then increase if I don't feel any better or if I feel better but need more. My GAD is ever present (with the exception of one day in the week when it just dissipated). I'm not actually "anxious" about anything, I just have intense physical feelings all the time whether I'm at home or out and about. It's just so physically and mentally tiring after 10 months.
So do I stick it out at 75mg for another few weeks or just bite the bullet and increase tomorrow? Last time on ven I had no side effects at all and felt better within 2 weeks. Now after so many months I'm starting to lose hope of ever feeling normal again. I'm having CBT but when there's nothing but fear of fear to treat its very hard to break the cycle!

Hi Pixie, just checking in on you, how are you doing?